Embolization by micro navigation for treatment of persistent type 2 Endoleaks after endovascular abdominal aortic aneurysm repair

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background:Endovascular repair has become established as a safe and effective method for treatment of abdominal aortic aneurysms. One major complication of this treatment is leakage, or endoleaks, of which type 2 leaks are the most common.Objective:To conduct a brief review of the literature and evaluate the safety and effectiveness of embolization by micronavigation for treatment of type 2 endoleaks.Method:A review of medical records from patients who underwent endovascular repair of abdominal aortic aneurysms identified 5 patients with persistent type 2 endoleaks. These patients were submitted to embolization by micronavigation.Results:In all cases, angiographic success was achieved and control CT scans showed absence of type 2 leaks and aneurysm sacs that had reduced in size after the procedure.Conclusion:Treatment of type 2 endoleaks using embolization by micronavigation is an effective and safe method and should be considered as a treatment option for this complication after endovascular repair of abdominal aortic aneurysms.

Translated abstract

Contexto:O reparo endovascular se estabeleceu como uma modalidade segura e efetiva no tratamento do Aneurisma de Aorta Abdominal. Uma das principais complicações deste tipo de tratamento é o Vazamento ou Endoleak, sendo o do tipo 2 o mais frequente deles.Objetivo:Fazer uma breve revisão de literatura e avaliar a segurança e a efetividade da embolização por micronavegação para o tratamento do Vazamento tipo 2.Método:A revisão dos prontuários dos pacientes submetidos ao Reparo Endovascular do Aneurisma de Aorta abdominal identificou cinco pacientes que apresentavam Endoleak tipo 2 persistente. Esses pacientes foram submetidos à embolização por micronavegação.Resultado:Em todos os casos, houve sucesso angiográfico e as tomografias de controle evidenciavam ausência de Vazamento tipo 2 e diminuição do saco aneurismático, após o procedimento.Conclusão:O tratamento do Endoleak tipo II por embolização por micronavegação é um método efetivo e seguro, sendo considerado uma opção para esta complicação após o Reparo Endovascular do Aneurisma de Aorta Abdominal.

Related collections

Most cited references 16

Record: found
Abstract: found
Article: not found

Long-term follow-up of type II endoleak embolization reveals the need for close surveillance.

Timur Sarac, Connor Gibbons, Lina Vargas … (2012)

Aneurysm growth after endovascular aneurysm repair (EVAR) in patients with type II endoleak is associated with adverse outcomes. This study evaluated the long-term success of embolization of type II endoleaks in preventing aneurysm sac growth. We retrospectively reviewed outcomes of patients who underwent infrarenal EVAR who were treated for a type II endoleak between 2000 and 2008. Computed tomography scans were evaluated for aneurysm sac growth or shrinkage from the time of treatment of the endoleak. The embolization material used, graft type, target vessel embolized, and comorbidities were evaluated for their association with sac growth or shrinkage. Ninety-five patients underwent 140 embolization procedures. The mean time from EVAR to embolization was 26.1 ± 22.2 months, and the average increase in size of the aneurysm sac from EVAR to treatment was 0.7 × 0.5 cm. Patients underwent an average of 1.6 ± 0.8 embolization procedures after EVAR. Thirteen patients underwent initial simultaneous embolization of two targets. Embolization was with glue (61%), coils (29%), glue and coils (7%), and Gelfoam (3%; Pfizer Inc, New York, NY). No abdominal aortic aneurysms (AAA) ruptured. Eight patients (8.4%) underwent graft explant and open repair; 19 (20%) required two or more embolization procedures. There was no difference in the target vessel treated or the treatment used in halting sac expansion (>5 mm). Coil embolization alone resulted in more second procedures. The 5-year cumulative survival was 65% (95% confidence interval [CI], 52%-77%), freedom from explant was 89% (95% CI, 81%-97%), freedom from second embolization was 76% (95% CI, 66%-86%), and freedom from sac expansion >5 mm was 44% (95% CI 30%-50%). Univariable analysis identified continued tobacco use (hazard ratio [HR], 2.30; 95% CI, 1.02-5.13; P = .04) was associated with continued sac expansion, and hyperlipidemia (HR, 9.64; 95% CI, 2.22-41.86) was associated with patients requiring a second embolization procedure. Embolization of type II endoleaks is successful early in preventing aneurysm sac growth and rupture after EVAR. However, a significant number of patients require more than one procedure, and at 5 years, many patients who underwent embolization of a type II endoleak continued to experience sac growth. Patients with hyperlipidemia who undergo coil embolization are more likely to require a second embolization procedure, and patients who smoke have a higher likelihood of AAA sac expansion after embolization. Continued long-term surveillance is necessary in this cohort of patients. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

0 comments Cited 24 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost-effective.

M Flye, Eric Steinmetz, David M Hovsepian … (2004)

The conservative versus therapeutic approach to type II endoleak after endovascular repair of abdominal aortic aneurysm (EVAR) has been controversial. The purpose of this study was to evaluate the safety and cost-effectiveness of the conservative approach of embolizing type II endoleak only when persistent for more than 6 months and associated with aneurysm sac growth of 5 mm or more. Data for 486 consecutive patients who underwent EVAR were analyzed for incidence and outcome of type II endoleaks. Spiral computed tomography (CT) scans were reviewed, and patient outcome was evaluated at either office visit or telephone contact. Patients with new or late-appearing type II endoleak were evaluated with spiral CT at 6-month intervals to evaluate both persistence of the endoleak and size of the aneurysm sac. Persistent (>or=6 months) type II endoleak and aneurysm sac growth of 5 mm or greater were treated with either translumbar glue or coil embolization of the lumbar source, or transarterial coil embolization of the inferior mesenteric artery. Type II endoleaks were detected in 90 (18.5%) patients. With a mean follow-up of 21.7 +/- 16 months, only 35 (7.2%) patients had type II endoleak that persisted for 6 months or longer. Aneurysm sac enlargement was noted in 5 patients, representing 1% of the total series. All 5 patients underwent successful translumbar sac embolization (n = 4) or transarterial inferior mesenteric artery embolization (n = 4) at a mean follow-up of 18.2 +/- 8.0 months, with no recurrence or aneurysm sac growth. No patient with treated or untreated type II endoleak has had rupture of the aneurysm. The mean global cost for treatment of persistent type II endoleak associated with aneurysm sac growth was US dollars 6695.50 (hospital cost plus physician reimbursement). Treatment in the 30 patients with persistent type II endoleak but no aneurysm sac growth would have represented an additional cost of US dollars 200000 or more. The presence or absence of a type II endoleak did not affect survival (78% vs 73%) at 48 months. Selective intervention to treat type II endoleak that persists for 6 months and is associated with aneurysm enlargement seems to be both safe and cost-effective. Longer follow-up will determine whether this conservative approach to management of type II endoleak is the standard of care.

0 comments Cited 22 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Type II endoleaks: predictable, preventable, and sometimes treatable?

Jarrod Scott, Jemila C. Kester, Emily Denton … (2002)

The purpose of this study was to evaluate the effect of preoperative coil embolization of lumbar and inferior mesenteric arteries on the incidence of type II endoleak after endovascular abdominal aortic aneurysm repair. The subjects were consecutive patients who underwent EVAR between January 1996 and January 2001. Patent aortic side branches were identified with preprocedural spiral computed tomographic scanning and calibrated angiography. Coil embolization was performed before EVAR. Patients were followed up with plain radiographs and ultrasound and dual phase spiral computed tomographic scans. Digital subtraction angiography was performed when endoleak was suspected. The outcome measures were the incidence of type II endoleaks and changes in maximum aortic sac diameter (Dmax). Forty patients underwent EVAR, with a median duration of follow-up of 24 months (range, 3 to 48 months). Before surgery, the inferior mesenteric artery was patent in 16 patients (45%) and the lumbar arteries in 21 patients (53%). Inferior mesenteric artery embolization was successful in 13 of 16 patients (81%). Lumbar embolization was attempted in 13 patients and was successful in eight (62%). During EVAR, successful sac exclusion was achieved in 38 patients (95%). None of the patients who underwent embolization before EVAR had type II endoleak develop, eight of 13 patients (62%) with patent lumbar arteries had endoleaks develop (P =.006), and three of these patients subsequently underwent successful coil embolization. Type II endoleak was associated with a 2.0-mm median increase in Dmax (P =.045). A 3.0-mm median reduction in Dmax was seen in the absence of type II endoleak (P =.002). Type II endoleaks are predictable, preventable, and sometimes treatable. Significant sac shrinkage occurs in the absence of lumbar endoleak but not in the presence of type II endoleak.

0 comments Cited 15 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Bruno Lorenção de Almeida: Role: ND

Antônio Massamitsu Kambara: Role: ND

Fabio Henrique Rossi: Role: ND

Marcelo Bueno de Oliveira Colli: Role: ND

Eduardo Silva Jordão de Oliveira: Role: ND

Patrick Bastos Metzger: Role: ND

Camila Baumann Beteli: Role: ND

Sthefanie Fauve Andrade Cavalcante: Role: ND

Journal

Journal ID (publisher): jvb

Title: Jornal Vascular Brasileiro

Abbreviated Title: J. vasc. bras.

Publisher: Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV) (Porto Alegre )

ISSN: 1677-7301

Publication date (Print): December 2014

Volume: 13

Issue: 4

Pages: 266-271

Affiliations

[1 ] Instituto Dante Pazzanese de Cardiologia Brazil

[2 ] Benemérita Sociedade de Beneficência Portuguesa de São Paulo Brazil

Article

Publisher ID: S1677-54492014000400266

DOI: 10.1590/1677-5449.0110

SO-VID: a5174ce3-1388-48eb-be51-29be9ff24213

License:

http://creativecommons.org/licenses/by/4.0/

History

Product

SciELO Brazil

Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1677-5449&lng=en

Embolization by micro navigation for treatment of persistent type 2 Endoleaks after endovascular abdominal aortic aneurysm repair Translated title: Embolização por micronavegação para tratamento de Endoleak tipo 2 persistente após reparo endovascular do aneurisma de aorta abdominal

Read this article at

Abstract

Translated abstract

Related collections

SciELO Brazil

Most cited references 16

Long-term follow-up of type II endoleak embolization reveals the need for close surveillance.

Type II endoleak after endovascular abdominal aortic aneurysm repair: a conservative approach with selective intervention is safe and cost-effective.

Type II endoleaks: predictable, preventable, and sometimes treatable?

Author and article information

Contributors

Journal

Affiliations

Article

History

Product

Categories

Comments

Comment on this article

Similar content 621

Most referenced authors 120